Hamid Hassan Flashcards
The salivary glands are exocrine merocrine glands, define exocrine and merocrine
Exocrine: secrete products through ducts opening onto epithelium
Merocrine: no part of cell lost during secretion by using vesicles and exocytosis
What type of fibres stimulate salivary secretion
Parasympathetic reflexes
Sympathetic stimulation
What is the acini
Secretory unit producing saliva
What is the pathway of the salivary gland and cell types throughout
Acinar cells cluster around lumen
Lumen empties into intercalated duct lined with simple cuboidal epithelium
Empties into striated duct of simple columnar
Empties into excretory duct of stratified cuboidal
Empties into collecting duct of stratified cuboidal
What is the difference in staining of serous and mucous acinar
Serious have basophilic secretory vesicles around lumen and are acidic so stain purple with HandE
Mucous stain paler with h and e
What are myoepithelial cells
Epithelial cells with muscular features that lie between basal lamina and basal membrane of acinar cells and intercalated duct
What do myoepithelial cells do
4
Reduce back flow of saliva
Accelerate outflow
Reduce luminar volume
Increase secretory pressure
What is a key feature of striated duct structure
2
Basal surface has foldings with mitochondria for energy to aid active transport
Luminar surface has microvilli to increase SA
What occurs in striated duct to make saliva hypotonic
Reabsorbtion of Na and Cl
Secretion of k and HCO3
How is the parotid gland divided
What is it’s duct called
Where does it’s duct empty
Deep part and superficial part divided by facial nerve
Stensons
Upper 2nd molar
What is blood supply to parotid gland
External carotid artery
What is the venous drainage of the parotid gland
External jugular vein
What structure is superior to parotid gland
TMJ
What structure is posterior to parotid gland
Mastoid process
What structure is anterior to parotid gland
Angle of mandible
Medial pterygoid plate
Massater
Stylomandibular ligament
What saliva is produced by submandibular gland
What is it’s duct and where does it drain
Mixed
Wartons
Lingual frenulum
How is the submandibular gland divided
Superficial part below mylohyoid and deep part above mylohyoid
What is the blood supply to submandibular gland
2
Submental artery
Sublingual artery
What is the venous drainage of submandibular gland
Submental vein into facial vein into internal jugular vein
What saliva is secreted by sublingual gland
What is it’s duct called and where does it empty
Mucous saliva
Bartholins
Several openings in floor of mouth
What is the blood supply of sublingual gland
2
Submental artery
Sublingual artery
What is the venous drainage of sublingual gland
Submental vein into facial vein into internal jugular vein
What is the most common type of minor salivary glands
Why is saliva from minor salivary duct high in sodium
Mucous
No intercalated or striated duct
Where are glands of Von ebner
What type of saliva do they produce
Circumvallate papillae
Serous
Where are mucous minor salivary glands found
3
Hard palate
Soft palate
Lingual tonsils
Where are serous minor salivary glands found
Lingual sulcus terminalis in circumvalate papillae
Where are mixed minor salivary glands found
Tip of tongue
What nerve innervates the parotid gland and what is it’s pathway to the parotid gland
Parasympathetic innervation from lesser petrosal nerve of glossopharyngeal
Inferior Salavitory nucleus in medulla
Through jugular foramen
Through tympanic canuliculus into middle ear
Out of middle ear and through hiatus of lesser petrosal nerve into middle cranial fossa
Through foramen ovale
Otic ganglion to parotid gland
What nerve innervates submandibular and sublingual glands
What is it’s pathway
Parasympathetic innervation via chorda tympani of facial nerve
Superior salavotory nucleus in pons
Through internal acoustic meatus as facial nerve to middle ear
Chorda tympani given off
Lingual nerve of V3 joins chorda tympani
Submandibular ganglion to SM and SL glands
What provides sympathetic innervation to the salivary glands
What is it’s pathway
T1-T4 Thoracic vertebrae 1-4 Super cervicular ganglion Internal carotid plexus Deep petrosal nerve SM SL and Parotid glands
How much saliva is produced a day
What % saliva is water
1-1.5 l
99%
What is whole saliva composed of
6
Saliva Epithelial cells Neutrophils Lymphocytes Bacteria GCF
What are the roles of saliva
11
Buffering Pellicle formation Remineralisation Salivary proteins Clensing Immunity Lubrication Digestion Taste Water balance Wound healing
What is the component in saliva responsible for buffering
What’s its concentration in stimulated and unstimulated saliva
Bicarbonate
Unstimulated 1mmol per litre
Stimulated 60mmol per litre
What reaction allows bicarbonate to buffer
HCO3- ➕ H+ ➡️ H2CO3 ➡️ H2O ➕ CO2
How thick is the pellicle
What does it do
2
1-10 micrometers
Diffusion barrier
Base of adhesion
How does saliva aid remineralisation
Increases concentration of ions available to remineralise hydroxyapatite
What are the salivary proteins in saliva
4
Statherin
Proline rich proteins
Cystatins
Histatins
What does statherin do
Prevents precipitation of calcium phosphate to maintain high calcium availability for remineralisation
What do proline rich proteins do
2
Maintain concentration of calcium in saliva by binding to it and adsorbing to hydroxyapatite surface
Inhibit hydroxyapatite growth
What do cystatins do
Inhibit proteases of periodontal disease
What do histatins do
Antimicrobial proteins that assist homeostasis and help pellicle formation
How does saliva repair early caries
Inhibitors in saliva prevent crystal growth in enamel on surface of lesion to keep pores open for remineralisation
How does saliva cleanse the oral cavity
Washes away noxious agents, bacteria and food debres to the gut
What is the role of IgA
Limits microbial adherence and agglutinate bacteria
Where is IgG derived from
GCF
What does lysozyme do
Breaks down bacteria walls
What does lactoferrin do
Binds to ions and inhibits Bacteria growth with lysozyme
What do mucins do
What glands are they derived from
Aggregate bacteria
sublingual, submandibular and minor salivary glands
What do histatins do
Helps form pellicle and inhibits candida albicans
What do defensins do
Aggregate bacteria and integrate into lipid bilayer to disrupt
How does saliva aid digestion
Amylase from parotid gland helps break down starch by hydrolising alpha 1,4 linkages into maltose and dextrin
How does saliva aid body water balance
When we are dehydrated saliva rate decreases causing dry mouth which stimulates tactile receptors which send impulses to hypothalamus to create conscious awareness of thirst
What is normal unstimulated flow
0.3-0.4 ml/min
What is normal stimulated flow
1-3ml / min
What is unstimulated flow in xerostoma
Below 0.1 ml /min
What is stimulated flow rate in xerostomia
Below 0.7ml / min
What drug is used for xerostoma
Pilocarpine
What are the main organs of GI tract
5
Oral cavity Oesophagus Stomach Small intestine Large intestine
What are the accessory organs of the GI tract
6
Teeth Tongue Salivary glands Liver Gall bladder Pancrease
What is the pH of the oral cavity
5-7
What type of epithelium line esophagus
Non keratinised stratified squamous
What are the laters of wall lining GI tract
4
Adventia / serosa
Muscularis externa
Submucosa
Mucosa
What is the difference between serosa layer or adventia layer
Serosa is slippery and serous, adventia is thick and fibrous
Where is serosa found
6
Stomach Spleen Liver Duodenum Transverse colon Sigmoid colon
Where is adventia found
5
Duodenum Cecum Ascending colon Descending colon Pancrease
What are the layers of muscularis externica and what do they do
3
Outer longitudinal- relaxes and lengthens to pull food forward
Myenteric plexus- causes smooth muscle relaxation when activated
Inner circular- contract and constrict behind food
What are the layers in mucosa in GI tract
3
Epithelial layer
Lamina propria
Muscularis mucosa
What is the role of liver in relation to GI tract
Makes bile
What are the muscle layers in muscularis externica of the stomach
3
Longitudinal
Circular
Oblique
What is the pH of the stomach
How long is food in stomach
pH1-3
30mins to 4 hours
What are the sphincters of the stomach
Cardiac sphincter
Pyloric sphincter
What are the areas of the stomach
5
Cardia Fundus Body Pyloric atrium Pyloric canal
What are the cells of the stomach lining and gastric pits and what do they secrete
5
Surface mucous cell : mucous Mucous neck cell : mucous Parietal cell : HCl Chief cell : pepsinogen Neuroendocrine cell
What hormone triggers release of bile from gall bladder
CCK
What does bile do
Emulsifies fad in lipid digestion
What is the endocrine function of the pancrease
Alpha cells secrete glucagon
Beta cells secrete insulin
What is the exocrine function of the pancrease
Acini secretes HCO3, tyripsinogen, nucleases, proteases, chymotripsinogen, amylase and lipase
Into interlobular duct
Into pancreatic duct
What is the optimum pH of pancreatic amylase
5.6-6.9
How does bile and pancreatic juice enter the duodenum
Hepatopancreatic sphincter
What is the ph of the small intestine
How long is food in the small intestine
pH 6-7.5
1-2 hours
What are the cells of the small intestine and what is there function
5
Enterocyte- absorbtion
Goblet cells- mucus secretion
Enteroendocrine cells- hormone secretion
Paneth cells- synthesis ofantimicrobial peptides
M cells- antigen presenting
Where are proliferating cells of small intestine found
Crypt of epithelium
What are the sections of the small intestine
Duodenum
Jejunum
Ileum
What are brunners glands, where are they and what do they do
Found in duodenum and increase pH between stomach and small intestine
Which segments of the small intestine have circular folds
Jejunum
Ilium
What are payers patches and where in GI tract are they found
Payers patches are an aggregation of lymphocytes for immune response found in the ilium
Where is B12 absorbed
Ilium
How are fatty acids and glycerol absorbed
Oral cavity- lingual lipase Stomach- gastric lipase Pancrease secretes bile and pancreatic lipase into duodenum Bile emulsifies lipids into miscelle Miscelle absorbed into enterocyte Through SER and RER Exocytosis of chylomicron into lactiles
How are proteins absorbed
Chief cells secrete pepsinogen which is converted to pepsin by HCl secreted by parietal cells
In duodenum CCK causes protease release into small intestine from pancrease
In small intestine brush border enzymes secrete peptidases
Amino acids and small peptides absorbed into enterocyte
How are carbohydrates absorbed
In oral cavity amylase secreted
CCK causes pancreatic amylase release into duodenum
In small intestine brush border enzymes on microvilli- lactase, Maltase, sucrase
Monosaccharides absorbed into enterocyte through GLUT5 and SGLT transporters
GLUT 2 transporters into intestinal capillaries to hepatic portal vein
What is the pH of the large intestine
How long does food stay in large intestine
pH 5-7
12-24 hours
What is absorbed in the large intestine 4
Water
Fibre
Bile salts
Vitamins
Which vitamins are absorbed in large intestine
3
K
Biotin B7
B5
What are the sections of the large intestine
Cecum Ascending colon Right colic fletcture Transverse colon Left colic flecture Descending colon Sigmoid colon
How does food pass from small to large intestine
Iliocecal sphincter
What are hastura and what do they do
What are tendiniae coli and what do they do
What are omental appendices and what do they do
Bubbles of large intestine which mix chyme and move food along
Longitudinal ribbons of smooth muscle that contract to produce hastara
Small pouches of fat with unknown function
Define physiological stress
The response of an organism to stressors with sympathetic and parasympathetic activity leading to physiological and behavioural responses
Define excercise stress
Changes in body to deal with demands of physical activity
What is the different between acute and chronic stress
Acute stress has short term responses whereas chronic stress is ongoing with damaging effects
What is the physiology of stress
5
Stress detected
Amygdala in brain stimulates hypothalamus
Hypothalamus activates sympathetic nervous system of ANS
Signals to adrenal medulla which secrete adrenaline and noradrenaline, signals to visceral effectors (smooth muscle, cardiac muscle m, glands)
Outcome
What are the stress hormones and what do they do?
5
Corticotropin releasing hormone: stimulates ACTH release
Adrenocorticotropic hormone: stimulates cortisol release
Cortisol: gluconeogenesis, proteolylis, reduces inflammation, surpression of immune system,reduced wound healing, reduced bone formation
Growth hormone releasing hormone: causes release of growth hormone from pituitary
Thyrotropin releasing hormone: causes secretion of thyroid stimulating hormone from pituitary gland
Where is corticotropin releasing hormone released Adrenocorticotropic hormone Cortisol Growth hormone releasing hormone Thyrotropin releasing hormone
Hypothalamus Pituitary gland Adrenal cortex Hypothalamus Hypothalamus
What is the physiology of excercise stress
8
Excercise
Oxygen and energy demand to muscles increases
ATP stores in muscles used up so more ATP made from creatine phosphate and ADP via anaerobic and aerobic respiration
In CV system sympathetic nervous system increases heart rate and has positive ionotrophic effect
Vasodilation in muscles increases oxygen delivery
Ventilation increases as increasing levels of CO2 are detected
Cortisol is released
Antidiuretic hormone and aldosterone are released to conserve water
What are the oral diseases associated with stress
7
Periodontal disease Bruxism Oral lichen planus TMJ PDS Recurrent aphthous ulcer Acute necrotising ulcerative gingivitis Dry mouth
What is normal blood glucose
4.4-6.1 mmol/L
What is hyperglycaemia level
Above 11.1 mmol/L
What is hypoglycaemia level
Below 2.8 mmol /L
Below 3.9 mmol /L in diabetic
How does the body respond to high blood glucose
6
High blood sugar detected by beta cells in islets of langerhan which produce insulin
Insulin binds to complementary receptors on muscle and liver
More GLUT4 transporters embedded into plasma membrane for facilitated diffusion of glucose
In liver enzymes activated to cause glycogenesos
Insulin increases cellular respiration
Insulin promotes synthesis of proteins and fatty acids and inhibits breakdown of adipose
How does the body respond to low blood glucose
6
Alpha cells in islets of langerhan produce glucagon
Glucagon binds to receptors on liver
Enzymes activated for gluconeogenesis
Enzymes activated for glycogenolysis
Facilitated diffusion of glucose out of liver into bloodstream
Glucagon reduces fatty acid synthesis and promotes lipolysis of adipose tissue
Which hormones other than insulin lower blood glucose and what secretes them
3
Amylin secreted by beta cells
GLP1 secreted by intestinal endocrine L cells
Somatostatin secreted by delta cells of pancrease
Which hormones other than glucagon raise blood sugar and what secretes them
6
Asprisin- white adipose Epinephrine- adrenal medulla Cortisol- adrenal cortex Adrenocorticotropic hormone- pituitary gland Growth hormone- pituitary gland Thyroxine-thyroid
What is type one diabetes and what percentage of diabetics are type 1
Body can’t produce enough insulin due to autoimmune attack of beta cells in pancrease caused by genetics with environmental influences
9%
What are the symptoms of type 1 and 2 diabetes
5
Polyurea Polydipsea Polyphagia Fatigue Weight loss
How is type 1 diabetes treated
Insulin
Lifestyle management
Diet management
What are complications of type 1 and 2 diabetes
4
CV disease
Diabetic retinopathy
Lower limb damage
Kidney failure
What is type 2 diabetes and how many diabetics are type 2
Ineffective use of insulin leading to insulin resistance caused by lifestyle with genetic factors
90%
What are the treatments for type 2 diabetes
4
Increased excercise
Weight loss
Low glycemic index diet
Metformin to reduce gluconeogenesis
What are the symptoms of low blood sugar
8
Trembling Heart pounding Sweating Hunger Numbness Sleepiness Irritability Headache
What are the symptoms of very low blood sugar
5
Confusion Blurred vision Difficulty speaking Seizures Coma
What is the lifespan of receptor cells of taste buds
10 days
How are salty tastes transduced
Sodium ions diffuse through protein channels into type 1 cells causing depolarisation
Depolarisation causes voltage gated calcium ion channels to open and calcium enters cell causing vesicles to release neurotransmitter
Neurotransmitter creates action potential in nerve fibres
How are sour tastes transduced
Hydrogen ions diffuse into type 3 cells through protein channels leading to depolarisation
Voltage gated calcium ion channels open and calcium enters
Vesicles release neurotransmitter causing action potential in nerve
How are bitter, umami, sweet tastes transduced
Tastants bind to G protein coupled receptors which are linked to transducin
Transducin binds to phospholipase c and activated it
Phospholipase c breaks down PIP2 into DAG and IP3
IP3 causes calcium release from SER
Calcium and IP3 open TRPM5 ion channels so sodium and potassium can enter cell and cause depolarisation
What is the difference between the orthonasal and retronasal pathway
Orthonasal through nostril to olfactory epithelium
Retronasal through mouth and nasopharynx to olfactory epithelium
What do warm receptors detect
What do cold receptors detect
Heating up
Cooling down
What is stress a risk factor of
2
Heart attack
Periodontal disease
What is poor diet a risk factor of
4
Obesity
Cancer
Heart disease
Caries
What is smoking a risk factor of
4
Cancer
Heart disease
Respiratory disease
Periodontal disease
What is alchohol a risk factor of
2
Heart disease
Trauma
What is low excercise a risk factor of
2
Obesity
Heart disease
What is poor hygiene a risk factor of
1
Periodontal disease
What are fat souluble vitamins
Which vitamins are these
Vitamins absorbed with fats in the diet that can be stored in the bodies fatty tissues
A D E K
What are water soluble vitamins
Which vitamins are water soluble
Vitamins that can dissolve in water and are not stored in the body
B1 B2 B3 B5 B6 B7 B9 B12 C
What is the name of vitamin A
What does it do (4)
Retinoids
Growth of epithelium
Component of pigment in rod cells
Maintains oral mucosa
Antioxidant prevents oral cancer
Where is vitamin A found (2)
What does it’s defficiency cause (3)
Beta carotene is it’s provitamin
Dark green, yellow and red vegetables
Night blindness with softening cornea
Periodontal disease
Enamel and dentine hypoplasia
What does vitamin A toxicity cause
7
Headaches Double vision Dizziness Bone and joint pain Hair loss Dermatitis Teratogenic
What is vitamin B1 called
What does it do
Thiamin
Carbohydrate metabolism and production of HCl in stomach
Where is B1 found (5)
What does B1 deficiency cause (5)
Peas Fruit Eggs Whole grain bread Fortified cereal
Loss of apetite Constipation Nausea Confusion Beriberi
What are the effects of beriberi
Cardiac failure
Oedema
What is vitamin B2 called
What does it do
Riboflavin
Helps metabolise lipids and carbohydrates and produce B3 and B6
Where is vitamin B2 found 6
What does vitamin B2 deficiency cause 4
Mushroom Cornflakes Yeast Liver Fish Eggs Pork
Scaly dermatitis
Photophobia
Glossitis
Angular cheilitis
What is vitamin B3 called
What does it do
Niacin
Forms part of coenzymes NAD and NADP and used to synthesise fats and sugars
Where is vitamin B3 found (7)
What does B3 deficiency cause (4)
Yeast Meat Fish Milk Eggs Green vegetables Made from amino acid tryptophan
Pellagra
Diorrhea
Dermatitis
Dementia
What is vitamin B12 called
What does it do
Cobalamin
Converts homocysteine to methionine which is an essential amino acid and helps make dna and maintain nerve cells and synthesise red blood cells
What does B12 require to be absorbed in the ileum
Intrinsic factor from parietal cell of stomach
Where is B12 found
What does B12 deficiency cause (5)
Animal products
Anamea Weight loss Fatigue Confusion Dementia
What is pernicious anaemia
Autoimmune disease caused by gastric atrophy and loss of intrinsic factor so B12 can’t be absorbed in ileum
What is vitamin B9 called
What does it do
Foliate/folic acid
Helps break down homocysteine to methionine and is important in gene expression
Where is B9 found (4)
What does B9 deficiency cause
Beans
Citrus fruit
Whole grain
Green leafy vegetables
Birth defects and premature birth
What is vitamin c called
What does it do
Ascorbic acid
Antioxidant that protects against cancer and is used to make collagen
Where is vitamin c found
What does deficiency cause (6)
Citrus fruits
Fragility Bleeding Muscle weakness Fatigue Malaise Scurvy
What are the oral effects of scurvy
3
Gingival bleeding and swelling
Loose teeth
Compromised immune function
What is vitamin D called
What does it do
Ergocalciferol
Helps metabolise calcium and phosphate in bone and moderates immune system
Where is vitamin D found (3)
What does vitamin d deficiency cause
Egg yolks
Fish liver oils
Sunshine
Rickets or osteomalacia
What are the symptoms of rickets or osteomalacia? 7
Pain Skeletal deformities Poor growth Fragile bones Richitic teeth Delayed eruption Increased caries risk
What is vitamin K called
What does it do
Phytonadione
Regulates blood clotting and bone metabolism and blood calcium levels and counteracts warfarin
Where is vitamin K found
What does vitamin k deficiency cause
Green leafy vegetables and synthesised by colonic bacteria
Easy bruising and excessive bleeding
What is kwashiorkor
Severe protein malnutrition
What are the cariostatic minerals
5
Molybdenum Vanadium Fluoride Strontium Lithium
What are the caries promoting minerals
3
Selenium
Cadmium
Lead
What are the branches of the common carotid artery
Where does is bifurcate
Internal carotid artery
External carotid artery
C4
What is the mnemonic for branches of external carotid artery
Some Anatomists Like Freaking Out Poor Medical Students
What are the branches of external carotid artery and where do they supply
8
Superior thyroid- larynx and thyroid
Ascending pharyngeal artery- soft palate and pharynx
Lingual artery- tongue
Facial artery- lower face
Occipital artery- occipital region
Posterior auricular artery- skin over mastoid and middle ear
Maxillary artery- ear, alveolus, pterygoid muscles, temporalis, palate, nasal, pharynx
Superficial temporal artery- temporal region
What is the pathway of ascending pharyngeal artery
Branches into 3
One branch through foramen lacerum
One branch through jugular foramen
One branch through hypoglossal canal
Where does the lingual artery arise
What nerve is it crossed by
Tip of greater horn of hyoid
Hypoglossal n
Where does the facial artery arise
What is it’s pathway
Arises just above greater horn of hyoid Runs upwards on superior constrictor muscle S turn curls around submandibular gland Gives off submental artery Crosses mandible
What is the pathway of posterior auricular artery
Arises above digastric muscle
Supplies skin over mastoid process
Branches to middle ear
What is the pathway of the maxillary
4,3,6
Enters infra temporal fossa
Gives off inferior alveolar, middle meningeal, accessory meningeal and ear branch
Passes between superior and inferior heads of lateral pterygoid muscle
Gives off medial pterygoid, lateral pterygoid and temporalis branch
Passes through pterygomaxilary fissure into pterygopalatine fossa
Gives off naso palate, anterior palatine, middle palatine, posterior palatine, posterior superior lateral nasal branch and pharyngeal branch
Where does the superficial temporal artery branch from
What is it’s pathway
Parotid gland
Passes over zygomatic process of temporal bone
Divides into frontal branch and parietal branch
What artery supplies central mandible
Inferior alveolar artery
What artery supplies peripheral mandible
Facial artery
Which areas drain into the retro mandibular vein
2
Superficial temporal vein
Maxillary vein
What drains into the external jugular vein
4
Posterior auricular
Retro mandibular
Posterior external jugular
Transverse cervical
What drains into the subclavian vein
3
External jugular vein
Anterior jugular vein
Internal jugular vein
What drains into internal jugular vein
7
Sigmoid sinus Inferior petrosal sinus Facial vein Lingual vein Occipital vein Superior thyroid vein Middle thyroid vein
Where does the subclavian vein drain into
Superior vena cava
